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Cypress Solution eNews 
October 29, 2010  -  Cypress Benefit Administrators
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topIn This Issue:
argusARGUS Advantage Series:
ARGUS Claim Review - a division of Cypress Benefit Administrators - guards against costly healthcare billing errors, issues with medical claims processing and other claim system deficiencies. Learn more about how this industry-leading system works via this series of occasional articles.

Understanding More About Pain Management Injections
ARGUS Claim Review helps control health care costs by carefully monitoring our clients' claims to ensure they are accurate and legitimate. In addition, ARGUS and Cypress continually monitor industry reports so that we are up-to-date on the latest regulations, as well as 'hot-spots' for medical claim errors and fraud. One of these 'hot-spots' is injection treatments.

Injections for back pain in the cervical, lumbar, and thoracic regions have become an increasingly popular means of treatment as they offer an alternative to surgical intervention. They can be more effective than oral prescriptions because the medication is delivered directly to the area causing the pain. However, as with any type of treatment, there are potentials for abuse and fraud.

Triggered in part by a substantial increase in claims for injection treatments, the Centers for Medicare and Medicaid Services (CMS) recently issued a memorandum stating that the HHS Office of the Inspector General (OIG) performed retrospective audits on claims for two common types of injections in 2006 and 2007 to investigate any problems. The results showed that $197 million dollars (for just two types of injections in a two-year period) should not have been paid by CMS alone.  This does not reflect the additional dollars billed to private insurance that also should not have been paid — unnecessary, excessive, and abusive treatment that causes all of our premiums to rise yearly.

Cypress Benefit Administrators and ARGUS can help protect your health plan from these inappropriate charges. We also want to provide information that can help you help your employees protect themselves from inappropriate treatments or charges. Learn more about the OIG audits and findings, as well as some basic guidelines regarding medical necessity and appropriateness of treatment for one of the most common types of injection.    <back to top>
If you have any questions or are looking for solutions, please feel free to contact us. We are happy to help!
Cypress Benefit Administrators